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Thread: Vernal Keratoconjunctivitis: 8 year-old asthmatic male with reduced vision

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    Arrow Vernal Keratoconjunctivitis: 8 year-old asthmatic male with reduced vision

    Vernal Keratoconjunctivitis: 8 year-old asthmatic male with reduced vision


    Chief Complaint:
    Decreased distance visual acuity for four months.

    History of Present Illness:
    The patient is an eight year-old white male who suffers from seasonal allergic rhinitis. He presents for an eye examination complaining of a four month history of decreased distance visual acuity. Of note, he has a history of phlyctenulosis superiorly in the right eye during the previous summer that resolved with lotepredonol 0.5% topical therapy.

    Past Ocular History:
    Unremarkable for surgery or trauma. He is mildly myopic with a current optical prescription of -1.75 spherical in both eyes (OU). Phlyctenulosis as noted above.

    Past Medical History:
    History of asthma and seasonal allergies throughout his childhood.

    Medications:
    His allergic rhinitis is treated with beclomethasone dipropionate nasal spray (Vanceril) and combined oral therapy of chlorpheniramine and pseudoephedrine (Kronofed, antihistamine and decongestant).

    Family History:
    Maternal grandparent with cataract, glaucoma and macular degeneration. Multiple myopic family members.

    Social History:
    The patient is a well-adjusted 2nd-grader who lives at home with his parents. He has had no known exposure to anyone with infectious eye disease.

    Ocular Examination:
    Moderate photophobia noted during the exam.
    Neurologic status: Alert and oriented x3, non-focal
    Visual Acuity, with correction (-1.75 sphere, OU): Right eye (OD)-- 20/40; Left eye (OS)20/40 (pinhole correction to 20/25 OD and OS)
    Extraocular motility: Full, both eyes (OU)
    Pupils: Normal with no relative afferent pupillary defect (RAPD)
    Confrontation Visual Fields: Full, OU
    Intra-ocular pressure: OD--17 mmHg; OS--18 mmHg
    Slit lamp examination: Limbal papillary reaction superiorly and bulbar conjunctival injection superiorly, OU (see Figure 1). Palbebral papillae are evident on the superior tarsal conjunctiva, OS, other-wise normal.
    Dilated Fundal Exam (DFE): No pallor or edema of disc, OU. Normal macula vessels and periphery, OU.
    Course:
    The patient's course and presentation is classic for vernal keratoconjunctivitis. The day of presentation, the patient was started on the topical steroid Lotomax (loteprednol etabonate 0.5%) BID and the topical antihistamine Optivar (azelastine 0.05%) BID. At his 1 week follow-up visit, the limbal and palpebral signs were resolving. The Lotamax was tapered off. At his 6 week follow-up, there was no sign of limbal involvement of disease and only mild papillae of the tarsal conjunctiva. The patient was continued on Optivar until symptoms resolved.

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    Discussion & Treatment:

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    Last edited by trimurtulu; 01-11-2009 at 10:36 PM.

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